Client issue
A leading pharmaceutical company sought support in understanding payer reactions to the 2024 Inflation Reduction Act (IRA) maximum fair price (MFP) negotiations and the implications for Commercial plan negotiations in the US market.
CRA approach
We conducted interviews with US commercial payer experts spanning payer channels and plan types to gauge their reactions to the MFP negotiation outcomes, with a particular focus on the implications for their commercial plan negotiations in 2026. We assessed which factors payers believe were considered during MFP negotiations and their interpretation of MFP outcomes by product. The culmination of these discussions was to understand their expected category management – the Part D formularies considering negotiated MFPs and the extent to which plans could leverage MFP to achieve lower Commercial prices. Using these findings and in-house CRA expertise, we analyzed the risks and opportunities for the client’s products that could be included in future MFP negotiations or for products that compete with negotiated products.
Client impact
This project provided a foundational understanding of the impact of the first round of IRA price negotiations on expected formulary coverage decisions for Commercial and Medicare channels. This research also highlighted key uncertainties regarding how to interpret CMS guidance on access requirements for negotiated products. This research enabled the client to gain a deeper understanding of payer viewpoints on the 2024 MFP negotiations and supported the preparation for potential future price negotiations for their assets.
